Medicare Compliance & Reimbursement

Power wheelchair use should be on the rise, disability advocates say.  The double threat of reduced reimbursement and more restrictive coverage guidelines hangs over medical suppliers' heads as the feds gear up for Operation Wheeler Dealer. Dealers and manufacturers hoping to glean more details about the fraud-fighting initiative targeting power wheelchairs and scooters were sorely disappointed by a Sept. 11 special open door forum on the issue. The Centers for Medicare & Medicaid Services briefly reviewed the astronomical spending increases for the mobility devices, then took comments only on the rather vague 10-point plan to tackle power wheelchair fraud it issued the previous week. CMS officials declined to answer questions about the project. In a brief appearance on the call, CMS chief Tom Scully did say there was no doubt that wheelchairs would be at the top of the list for inherent reasonableness review. "It's not optional," Scully told listeners. But cuts are not guaranteed. Based on the review, CMS may keep reimbursement levels the same or even add to them if warranted, Scully noted. Scully was responding to several meeting attendees who insisted that IR cuts to wheelchair and scooter rates would have little to no effect on fraud and abuse of the items. "The only people you're going to hurt by that are the honest legitimate people that are left" in the wheelchair industry, insisted Doug Harrison, founder and president of The Scooter Store, representing the Power Mobility Coalition. Fraudsters who furnish no equipment when billing for expensive chairs or furnish low-end equipment at high-end prices will still see huge profits even if Medicare reduces power wheelchair payment rates by 15 percent, Harrison said. Honest, law-abiding providers' businesses would be slammed down to "near non-existent profit margins." The current reimbursement rate goes to cover services such as evaluations by occupational therapists and other clinical services, pointed out Meir Raskas of Advanced Medical Concepts, a Baltimore, MD supplier. Raskas implored CMS not to take a "shotgun approach" to wheelchair pricing that would harm legitimate suppliers. It's crucial "that the reimbursement and the good apples in our industry are not affected by the clean-up," Raskas maintained.

Hard Line Could Lead to Hard Time  CMS stressed that the agency is taking a hard line on fraud and abuse of these mobility products, but assured listeners that compliant suppliers had nothing to fear from the crackdown. Honest businessmen "have no reason to be concerned about these measures we're taking," one CMS official said. Commenters both attending the meeting in person in Baltimore and calling into the conference were less sure of the initiative's unintended consequences, however. In addition to IR cuts, restrictive coverage guidelines and medical review policies could harm legitimate providers' businesses, participants [...]